Immune history influences SARS-CoV-2 booster impacts: the role of efficacy and redundancy

Publication date: Mar 07, 2024

Given the continued emergence of SARS-CoV-2 variants of concern as well as unprecedented vaccine development, it is crucial to understand the effect of the updated vaccine formulations at the population level. While bivalent formulations have higher efficacy in vaccine trials, translating these findings to real-world effectiveness is challenging due to the diversity in immune history, especially in settings with a high degree of natural immunity. Known socioeconomic disparities in key metrics such as vaccine coverage, social distancing, and access to healthcare have likely shaped the development and distribution of this immune landscape. Yet little has been done to investigate the impact of booster formulation in the context of host heterogeneity. Using two complementary mathematical models that capture host demographics and immune histories over time, we investigated the potential impacts of bivalent and monovalent boosters in low- and middle-income countries (LMICs). These models allowed us to test the role of natural immunity and cross-protection in determining the optimal booster strategy. Our results show that to avert deaths from a new variant in populations with high immune history, it is more important that a booster is implemented than which booster is implemented (bivalent vs. monovalent). However, in populations with low preexisting immunity, bivalent boosters can become optimal. These findings suggest that for many LMICs – where acquiring a new vaccine stock may be economically prohibitive – monovalent boosters can still be implemented as long as pre-existing immunity is high.

Concepts Keywords
Agnostic Bivalent
Boosting345 Booster
Python Deaths
Vaccine Figure


Type Source Name
disease IDO history
disease VO vaccine
disease VO population
disease VO effectiveness
disease IDO host
disease VO time
disease IDO pathogen
disease IDO intervention
disease MESH viral shedding
disease VO vaccination
disease IDO pathogen host
disease MESH infections
disease VO Viruses
disease MESH influenza
disease IDO infection
disease VO vaccinated
disease IDO country
disease MESH death
disease VO immunization
disease VO effective
drug DRUGBANK Aspartame
drug DRUGBANK Ranitidine
disease IDO susceptibility
disease VO viable
drug DRUGBANK Isoxaflutole
disease VO vaccine strain
disease VO vaccine efficacy
disease VO organization
disease VO unvaccinated
disease IDO algorithm
disease MESH SARS CoV 2 infection
disease MESH reinfection
disease VO titer

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